CBCS BILLING AND CODING EXAM
400+QUESTIONS AND CORRECT DETAILED
ANSWERS|ALREADY GRADED A+
Medical Billing & Coding as a Career - ANSWER>>*Claims assistant professional or claims
manager, *Coding Specialist, * Collection Manager, *Electronic Claims Processor, *Insurance
Billing Specialist, * Insurance Coordinator, *Insurance Counselor, *Medical Biller, *Medical &
Financial Records Manager, * Billing & Coding Specialist
What are Medical Ethics? - ANSWER>>Standards of conduct based on moral principle. They are
generally accepted as a guide for behavior towards pt's, dr's, co-workers, the gov, and ins co's.
What does acting within ethical behavior boundaries mean? - ANSWER>>carrying out one's
responsibilities w/ integrity, dignity, respect, honesty, competence, fairness, & trust.
Compliance regulations: - ANSWER>>Most billing-related cases are based on HIPPA and False
Claims Act
Health Insurance Portability & Accountability Act (HIPAA) - ANSWER>>Enacted in 1996, created
by the Health Care Fraud & Abuse Control Program-enacted to check for fraud and abuse in the
Medicare/Medicaid Programs and private payers
What are the 2 provisions of HIPPA? - ANSWER>>Title I: Insurance Reform
Title II: Administrative Simplification
What is Title I of HIPPA? - ANSWER>>Insurance Reform-primary purpose is to provide
continuous ins coverage for worker & their dependents when they change or lose jobs. Also
*Limits the use of preexisting conditions exclusions *Prohibits discrimination from past or
present poor health *Guarantees certain employees/indv the right to purchase new health ins
coverage after losing job *Allows renewal of health ins cov regardless of an indv's health cond.
that is covered under the particular policy.
What is Title II of HIPPA? - ANSWER>>Administrative Simplification-goal is to focus on the
health care practice setting to reduce administrative cost & burdens. Has 2 parts- 1)
development and implementation of standardized health-related financial & administrative
,activities electronically 2) Implementation of privacy & security procedures to prevent the
misuse of health info by ensuring confidentiality
What is the False Claims Act (FCA)? - ANSWER>>Federal law that prohibits submitting a
fraudulent claim or making a false statement or representation in connection w/ a claim. Also
protects & rewards whistle-blowers.
What is the National Correct Coding Initiative (NCCI)? - ANSWER>>Developed by CMS to
promote the national correct coding methodologies & to control improper coding that lead to
inappropriate payment of Part B health ins claims.
How many edits does NCCI include? - ANSWER>>2: 1)Column 1/Column 2 (prev called
Comprehensive/Component) Edits
Column 1/Column 2 edits (NCCI) - ANSWER>>Identifies code pairs that should not be billed
together b/c 1 code (Column 1) includes all the services described by another code (Column 2)
Mutually Exclusive Edits (NCCI) - ANSWER>>ID's code pairs that, for clinical reasons, are unlikely
to be performed on the same pt on the same day
What are the possible consequences of inaccurate coding and incorrect billing? -
ANSWER>>*delayed processing & payment of claims *reduced payments, denied claims *fine
and/or imprisonment *exclusion from payer's programs, loss of dr's license to practice med
Who has the task of investigate and prosecuting health care fraud & abuse? - ANSWER>>The
Office of Inspector General (OIG)
Fraud - ANSWER>>knowingly & intentionally deceiving or misrepresenting info that may result
in unauthorized benefits. It is a felony and can result in fines and/or prison.
Who audits claims? - ANSWER>>State & federal agencies as well as private ins co's
What are common forms of fraud? - ANSWER>>billing for services not furnished, unbundling, &
misrepresenting diagnosis to justify payment
Abuse - ANSWER>>incidences or practices, not usually considered fraudulent, that are
inconsistent w/ the accepted medical business or fiscal practices in the industry.
,What are examples of Abuse? - ANSWER>>submitting a claim for services/procedures
performed that is not medically necessary, and excessive charges for services, equipment or
supplies.
What is a method use to minimize danger, hazards, & liabilities associated w/ abuse? -
ANSWER>>Risk Management
Patient Confidentiality - ANSWER>>All pt's have right to privacy & all info should remain
privileged. Only discuss pt info when necessary to do job. Obtain a signed consent form to
release medical info to ins co or other individual.
When may providers use PHI (Protected Health Information) w/o specific authorization under
the HIPPA Privacy Rule? - ANSWER>>When using for TPO, Treatment (primarily for the purpose
of discussion of pt's case w/ other dr's) Payment (providers submit claims on behalf of pt's) &
Operations (for purposes such as training staff & quality improvement)
What is Employer Liability? - ANSWER>>Means physicians are legally responsible for their own
conduct and any actions of their employees (designee) performed w/in the context of their
employment. Referred to as "vicarious liability. A.K.A "respondent superior"-"let the master
ANSWER". Means employee can be sued & brought to trial
What is Employee Liability? - ANSWER>>"Errors & Omissions Insurance"-protection against loss
of monies caused by failure through error or unintentional omission on the part of the indv or
service submitting the claim. ****Some dr's contract w/ a billing service (clearinghouse) to
handle claims submission, & some agreements contain a clause stating that the dr will hold the
co harmless from "liability resulting from claims submitted by the service for any account",
means dr is responsible for mistakes made by billing service, errors & omissions is not needed
in the instance. ******However, if dr ever asks the ins biller to do the least bit questionable,
such as write of pt's balances for certain pt's automatically, make sure you have a legal
document or signed waiver of liability relieving you of responsibility for such actions.
What is a Medical Record & what is it comprised of? - ANSWER>>documentation of the pt's
social & medical history, family history, physical exam findings, progress notes, radiology & lab
results, consultation reports and correspondence to pt- Is the foremost tool of clinical care and
communication.
What is a medical report? - ANSWER>>part of the medical record & is a permanent legal
document that formally states the consequences of the pt's exam or treatment in letter or
, report form. IT IS THIS RECORD THAT PROVIDES INFO NEEDED TO COMPLETE THE INS CLAIM
FORM.
Reasons for Documentation - ANSWER>>Important that every pt seen by dr has comprehensive
legible documentation about pt's illness, treatment, & plans for following reasons:
Retention Of Medical Records - ANSWER>>Is governed by state & local laws & may vary from
state-to-state. Most dr are required to retain records indefinitely, deceased pt records should
be kept for @ least 5 years
-algia - ANSWER>>pain
-emia - ANSWER>>blood condition
-itis - ANSWER>>inflammation
-megaly - ANSWER>>enlargement
-meter - ANSWER>>measure
-oma - ANSWER>>tumor, mass
-osis - ANSWER>>abnormal condition
-pathy - ANSWER>>disease condition
-rrhagia - ANSWER>>bursting forth of blood
-rrhea - ANSWER>>discharge, flow
-sclerosis - ANSWER>>hardening
-scopy - ANSWER>>to view
-centesis - ANSWER>>surgical puncture
-ectomy - ANSWER>>removal, resection, excision
400+QUESTIONS AND CORRECT DETAILED
ANSWERS|ALREADY GRADED A+
Medical Billing & Coding as a Career - ANSWER>>*Claims assistant professional or claims
manager, *Coding Specialist, * Collection Manager, *Electronic Claims Processor, *Insurance
Billing Specialist, * Insurance Coordinator, *Insurance Counselor, *Medical Biller, *Medical &
Financial Records Manager, * Billing & Coding Specialist
What are Medical Ethics? - ANSWER>>Standards of conduct based on moral principle. They are
generally accepted as a guide for behavior towards pt's, dr's, co-workers, the gov, and ins co's.
What does acting within ethical behavior boundaries mean? - ANSWER>>carrying out one's
responsibilities w/ integrity, dignity, respect, honesty, competence, fairness, & trust.
Compliance regulations: - ANSWER>>Most billing-related cases are based on HIPPA and False
Claims Act
Health Insurance Portability & Accountability Act (HIPAA) - ANSWER>>Enacted in 1996, created
by the Health Care Fraud & Abuse Control Program-enacted to check for fraud and abuse in the
Medicare/Medicaid Programs and private payers
What are the 2 provisions of HIPPA? - ANSWER>>Title I: Insurance Reform
Title II: Administrative Simplification
What is Title I of HIPPA? - ANSWER>>Insurance Reform-primary purpose is to provide
continuous ins coverage for worker & their dependents when they change or lose jobs. Also
*Limits the use of preexisting conditions exclusions *Prohibits discrimination from past or
present poor health *Guarantees certain employees/indv the right to purchase new health ins
coverage after losing job *Allows renewal of health ins cov regardless of an indv's health cond.
that is covered under the particular policy.
What is Title II of HIPPA? - ANSWER>>Administrative Simplification-goal is to focus on the
health care practice setting to reduce administrative cost & burdens. Has 2 parts- 1)
development and implementation of standardized health-related financial & administrative
,activities electronically 2) Implementation of privacy & security procedures to prevent the
misuse of health info by ensuring confidentiality
What is the False Claims Act (FCA)? - ANSWER>>Federal law that prohibits submitting a
fraudulent claim or making a false statement or representation in connection w/ a claim. Also
protects & rewards whistle-blowers.
What is the National Correct Coding Initiative (NCCI)? - ANSWER>>Developed by CMS to
promote the national correct coding methodologies & to control improper coding that lead to
inappropriate payment of Part B health ins claims.
How many edits does NCCI include? - ANSWER>>2: 1)Column 1/Column 2 (prev called
Comprehensive/Component) Edits
Column 1/Column 2 edits (NCCI) - ANSWER>>Identifies code pairs that should not be billed
together b/c 1 code (Column 1) includes all the services described by another code (Column 2)
Mutually Exclusive Edits (NCCI) - ANSWER>>ID's code pairs that, for clinical reasons, are unlikely
to be performed on the same pt on the same day
What are the possible consequences of inaccurate coding and incorrect billing? -
ANSWER>>*delayed processing & payment of claims *reduced payments, denied claims *fine
and/or imprisonment *exclusion from payer's programs, loss of dr's license to practice med
Who has the task of investigate and prosecuting health care fraud & abuse? - ANSWER>>The
Office of Inspector General (OIG)
Fraud - ANSWER>>knowingly & intentionally deceiving or misrepresenting info that may result
in unauthorized benefits. It is a felony and can result in fines and/or prison.
Who audits claims? - ANSWER>>State & federal agencies as well as private ins co's
What are common forms of fraud? - ANSWER>>billing for services not furnished, unbundling, &
misrepresenting diagnosis to justify payment
Abuse - ANSWER>>incidences or practices, not usually considered fraudulent, that are
inconsistent w/ the accepted medical business or fiscal practices in the industry.
,What are examples of Abuse? - ANSWER>>submitting a claim for services/procedures
performed that is not medically necessary, and excessive charges for services, equipment or
supplies.
What is a method use to minimize danger, hazards, & liabilities associated w/ abuse? -
ANSWER>>Risk Management
Patient Confidentiality - ANSWER>>All pt's have right to privacy & all info should remain
privileged. Only discuss pt info when necessary to do job. Obtain a signed consent form to
release medical info to ins co or other individual.
When may providers use PHI (Protected Health Information) w/o specific authorization under
the HIPPA Privacy Rule? - ANSWER>>When using for TPO, Treatment (primarily for the purpose
of discussion of pt's case w/ other dr's) Payment (providers submit claims on behalf of pt's) &
Operations (for purposes such as training staff & quality improvement)
What is Employer Liability? - ANSWER>>Means physicians are legally responsible for their own
conduct and any actions of their employees (designee) performed w/in the context of their
employment. Referred to as "vicarious liability. A.K.A "respondent superior"-"let the master
ANSWER". Means employee can be sued & brought to trial
What is Employee Liability? - ANSWER>>"Errors & Omissions Insurance"-protection against loss
of monies caused by failure through error or unintentional omission on the part of the indv or
service submitting the claim. ****Some dr's contract w/ a billing service (clearinghouse) to
handle claims submission, & some agreements contain a clause stating that the dr will hold the
co harmless from "liability resulting from claims submitted by the service for any account",
means dr is responsible for mistakes made by billing service, errors & omissions is not needed
in the instance. ******However, if dr ever asks the ins biller to do the least bit questionable,
such as write of pt's balances for certain pt's automatically, make sure you have a legal
document or signed waiver of liability relieving you of responsibility for such actions.
What is a Medical Record & what is it comprised of? - ANSWER>>documentation of the pt's
social & medical history, family history, physical exam findings, progress notes, radiology & lab
results, consultation reports and correspondence to pt- Is the foremost tool of clinical care and
communication.
What is a medical report? - ANSWER>>part of the medical record & is a permanent legal
document that formally states the consequences of the pt's exam or treatment in letter or
, report form. IT IS THIS RECORD THAT PROVIDES INFO NEEDED TO COMPLETE THE INS CLAIM
FORM.
Reasons for Documentation - ANSWER>>Important that every pt seen by dr has comprehensive
legible documentation about pt's illness, treatment, & plans for following reasons:
Retention Of Medical Records - ANSWER>>Is governed by state & local laws & may vary from
state-to-state. Most dr are required to retain records indefinitely, deceased pt records should
be kept for @ least 5 years
-algia - ANSWER>>pain
-emia - ANSWER>>blood condition
-itis - ANSWER>>inflammation
-megaly - ANSWER>>enlargement
-meter - ANSWER>>measure
-oma - ANSWER>>tumor, mass
-osis - ANSWER>>abnormal condition
-pathy - ANSWER>>disease condition
-rrhagia - ANSWER>>bursting forth of blood
-rrhea - ANSWER>>discharge, flow
-sclerosis - ANSWER>>hardening
-scopy - ANSWER>>to view
-centesis - ANSWER>>surgical puncture
-ectomy - ANSWER>>removal, resection, excision
